Formulary guidance and transparency from P&T to point of care

Barbra Golub

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Radar On Market Access: Health Insurers Turn to Data Analytics to Combat Fraud, Waste and Abuse

Posted by Barbra Golub on Aug 29, 2019

According to the National Health Care Anti-Fraud Association, health insurers lose more than $10 billion each year to health care fraud, waste and abuse. And according to experts, while strides have been made in combatting fraud, there is always going to be some new product ripe for fraud, along with the targets that have been around for years.

Melissa Jampol, an attorney with Epstein Becker Green and former assistant U.S. attorney, tells AIS Health that "insurers need to stay one step ahead of the trends." She is a big proponent of data analytics, contending that robust analytics help insurers analyze prepayment claims and audit results, trying to prevent fraud before it happens and catch it after the fact.
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Topics: Industry Trends, Provider, Payer